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Anestesilogo Jefe SAMU Regin de Los Lagos Dipl. Gestin Instituciones de Salud Dipl. Medicina Aeroespacial Sin conflicto de intereses
Estmago lleno Potencial dao columna cervical Mala iluminacin y trabajo en espacios confinados
Riesgo Aspiracin Pulmonar Dificultad manejo V.A. Dificultad manejo V.A. Morbilidad por desconocer condicin real del dao Morbimortalidad por recursos insuficientes
Dao multisistmico
Mltiples vctimas
Caractersticas
Consecuencias
Cdigo Sanitario
ATLS
ASA
RCP: 5:1 15:2
que la intubacin traqueal realizada por personal inexperto puede asociarse con alta tasa de complicaciones
1. 2.
IOT interrumpe el aporte de Oxigeno durante la RCP Uso de hipnoinductores y BNM. Riego/beneficio llegar a no puedo
3.
2 ms intentos fallidos de IOT, traumatiza va area, edema y sangrado dificultad progresiva hasta prdida de la ventilacin Bolsa-Mscara
A mayor expertice del personal en manejo de la va area, mayor sobrevida y outcome del paciente La sobrevida de los pacientes crticos es similar en aquellos IOT y los ventilados Bolsa mscara
4.
5.
Benumof JL, Anesthesiology 1991:75: 1087-1110 Practice Guidelines for Management of the Difficult Airway. Anesthesiology 1993:78:597-602 An update report by ASA Task Force Management of the Difficult Airway. Anesthesiology
2003:95: 1269-1277
Nivel de educacin y entrenamiento necesario para el uso seguro de una tcnica especfica.
Entrenamiento Avanzado:
Entrenamiento Intermedio:
Ventilacin Bolsa Mscara Dispositivos Supraglticos IOT IOT ISR Mdicos entrenados Especialistas
Entrenamiento Bsico:
Berlac P, Hyldmo PK, Kongstad P, et Al. Pre-Hospital airway management guidelines a task force from Scandinavian Society for Anaesthesiology and Intensive Care Medicine. Acta Anaesthesiol Scand 2008; 52: 897-907
1.
Cnulas farngeas
2.
Mscara facial
Mscara larngea
3.
4.
Tubos endotraqueales
Kurolan JO, Turunen MJ, Laakso JP et al. A comparison of the laryngeal tube and bagvalve mask ventilation by emergency medical technicians: a feasibility study in anesthetized patients. Anesth Analg 2005; 101: 1577-81 Doerges V, Sauer C, Ocker H et al. Airway management durin cardiopulmonary resuscitation a comparative study of bagvalve-mask, laryngeal mask airway and combitube ina a bench model. Resuscitation 1999; 41: 63-9
Stone BJ, Chantler PJ, Baskett PJ. The incidence of regurgitation during cardiopulmonary resuscitation: a comparinson between the bag valve mask and laryngeal mask airway. Resuscitation 1998; 38: 3-6.
Fcil aprendizaje
Brain AIJ, Verghese C, Addy EV, Kapila A. The intubating laryngeal mask, I: development of a new device for intubation of the trachea. Br. J Anasth 1997; 79:699-703.
Davies PR, Tigue SQ, Greenslade GL et al. Laryngeal mask airway and tracheal tube insertion by unskilled personnel. Lancet 1990; 336: 977-9.
Pennant JH, Walker MB. Comparision of the endotracheal tube and laryngeal mask in airway management by paramedical personnel. Anesth Analg 1992: 74: 531-4. Martin PD, Cyna AM, Hunter WA et al. Training nursing staff in airway management for resuscitation. A clinical comparision of the facemask and laryngeal mask. Anaesthesia 1993; 48: 33-7.
Brain AIJ, Verghese C, Strube PJ. The LMA ProSeal- a laryngeal mask with an oesophageal vent. Br. J Anasth 2000; 84:650-654.
Evans NR, Gardner SV, James MFM, ProSeal laryngeal mask protects against aspitration of fuid in the pharinx. Br. J Anaesth 2002; 88: 584-587.
No recomendado por la Task Force Sacandinavian por mayor dificultad de insercin frente a cLMA
Ferson DZ, Chi L, Zambare S Brown D. The effectiveness of the LMA Supreme in patients with
Drges V, Ocker H, Wenzel V et al. The Laryngeal Tube S: a modified simple airway device. Anesth Analg 2003; 96: 618-621.
Kurolan JO, Turunen MJ, Laakso JP et al. A comparison of the laryngeal tube and bag-valve mask ventilation by emergency medical technicians: a feasibility study in anesthetized patients. Anesth Analg 2005; 101: 1577-81
Kette F, Reffo I, Giordani G et al. The use of laryngeal tube by nurses in out of hospital emergencies: preliminary experiences. Resuscitation 2005; 66: 21-5
Ningn estudio, ctedra , fabricante u opinin de expertos avala su insercin en pacientes con reflejos de va area presentes. Aumenta riesgo de nuseas, vmitos y aspiracin. Laringoespasmo.
Gold Standard
Gausche M, Lewis RJ, Stratton SJ et al. Effect of out of hospital pediatric endotracheal intubation on survival and neurological outcome: a controled clinical trial. JAMA 2000; 283: 783-90. Davis DP, Dunford JV, Poste JC et al. The impact of hypoxia an hyperventilation on outcome after paramedic rapid sequence intubation of severely head injured patients. J Trauma 2004; 57:1-8. DiRusso SM, sullivan T, Risucci D et al. Intubation of pediatric trauma patients in the field: predictor of negative outcome despite risk stratification. J trauma 2005; 59: 84-90. Bochiccio GV, Ilahi O, Joshi M et al. Endotracheal intubation in the field does not improve outcome in trauma patienst who present without an acutely lethal traumatic brain injury. J trauma 2003, 54: 307-11
Klemen P, Grmec S, Effect of prehospital advanced life support with rapid sequence intubation on outcome of severe traumatic brain injury. Acta Anaesthesiol Scand 2006; 50: 1250-4
En contra
A favor
8% uso BNM
Adnet F, Jouriles NJ, Le TP et al. Survey of out of hospital emergency intubations in
N= 691
the French prehospital medical system: a multicenter study. Ann Emerg Med 1998; 32: 454-60.
N= 147 nios
Meyer G, Orliatguet G, Blanot S et al. Complications of emergency tracheal
intubation in severely head injury children. Paediatr Anaesth 2000; 10: 253-60.
pharmacologic agent to facilitate endotracheal intubation by paramedics. Prehosp Emerg Care 1999; 3: 191-3
prehospital ventilation by capnography in major trauma victims. Br j Anaesth 2003; 90: 327-32.
PaCO2
Presin IntraCraneana
Operador Paciente
Dispositivos